Net neutrality changed the digital landscape for millions of Americans, specifically physicians and health care professionals, but these changes may diminish due to the repeal of net neutrality. In December, the Federal Communications Commission voted to repeal the net neutrality rules set in place by the Obama Administration in 2015, and on June 11, 2018, net neutrality was officially repealed leaving many questions for Americans. Previously, most professionals were unfazed by the net neutrality rules, and many are still unaware of the positive impact net neutrality had in areas of the health care profession, such as telemedicine and technology education since it passed in 2015. Despite these technological advancements, many doctors still do not understand net neutrality or the effect the repeal could have on their practice or their financial bottom lines.

What is net neutrality?

Net neutrality is the concept that Internet Service Providers (ISPs) like Verizon, AT&T, Comcast and Spectrum are required to handle all data equally. The previous net neutrality rules protected against blocking, throttling and prioritization — meaning ISPs were not able to slow down or block some websites but speed up others. Net neutrality required all websites to load at equal speeds and treated all online content fairly. It also protected the consumer from paying more for slower internet speeds. In other words, all internet users were on a level playing field with the same rights to equally fast internet, and all websites were available at the same speed and quality.

What does life look like without net neutrality rules?

Without net neutrality, non-profit and educational websites and databases could be de-prioritized in lieu of commercial websites, meaning the importance of educational materials and research would be left up to the internet service providers. Allowing ISPs the ability to decide the importance of internet content leaves the potential for the medical and academic community to suffer because their content could potentially load at slower speeds or worse, blocked. Additionally, slower internet speeds will affect the ability to live-stream, upload and download promptly. Finally, many worry ISPs could offer multiple plans with different options on internet speed, leaving consumers paying more for high-speed internet. Overall, a divide will form between those who can afford faster internet service options and those who are stuck with slower bandwidth.

What does this mean for physicians?

For physicians and health care professionals, the repeal of net neutrality leaves the potential for devastating effects. First, medical professionals could be forced to pay significantly more for high-speed internet capable of downloading, uploading, sending and receiving digital medical records. Also, all the advancements made in telemedicine could become stagnant. Despite recent advancements, the future of telemedicine remains uncertain even if a physician can afford the high-speed internet to treat patients, many patients may not be able to afford the high-speed internet capable of live-streaming with their physician. Additionally, the repeal could be detrimental for physicians practicing in rural areas or with patients living in rural areas reliant on telemedicine.

Likewise, educational endeavors could suffer a significant impact. It could cost more for high-speed internet capable of downloading and uploading medical books and research vital to medical education, leaving medical students with the potential for an increase in tuition. Physicians could find it harder to stay up-to-date on the most recent research and studies in their field if educational and non-profit websites become overshadowed by commercial websites paying ISPs. Finally, the competition created between commercial websites and educational and non-profit websites will hinder and slow-down research. Overall, net neutrality created a level playing field on the internet making it possible for technological advancements that empower physicians with the education and tools they need to best care for their patients.

What can the medical community do now?

As of right now, ISPs have not changed their services despite the repeal of the net neutrality rules. In fact, many ISPs have publically stated they will not block or throttle but have left open the potential to charge more for some data transportation. On the contrary, just because an ISP publically states it will continue as if net neutrality is still in place does not mean it is locked into obeying that standard. As time goes on without net neutrality, look out for changes with ISPs. Many predict the changes will start small and add up over time.

How can you make a difference?

The U.S. Senate voted to reinstate the net neutrality rules repealed in December. The legislation is currently in the U.S. House of Representatives where it is given little hope of advancing. Contact your district’s representative and express your concerns over the end of net neutrality and the effects it will have on physicians and health care professionals.

Net neutrality has changed the digital landscape for millions of Americans, specifically physicians and health care professionals, but that could all change on June 11. In December, the Federal Communications Commission voted to repeal the net neutrality rules set in place by the Obama Administration, and on June 11 the repeal of net neutrality is set to take effect. Many professionals are unaware of the positive impact net neutrality has had in areas of the health care profession, such as telemedicine and technology education since it passed in 2015. Despite these technological advancements, many doctors still do not understand net neutrality, or the potential effect the repeal will have on their practice.

What is net neutrality?

Net neutrality is the concept that Internet Service Providers (ISPs) like Verizon, Comcast and Spectrum are required to handle all data equally. Meaning ISPs cannot slow down some websites and speed up others. Net neutrality operates all websites loading at equal speeds and treats all content online fairly. Also, it protects the consumer from paying more money for slower internet speeds. Net neutrality keeps everyone on a level playing field with everyone having the same rights to the equally fast internet, and all websites are available at the same speed and quality.

Life without net neutrality

Without net neutrality, non-profit and educational websites and databases run the risk of being de-prioritized for commercial websites, meaning the importance of educational materials and research is left up to the internet service providers. Allowing ISPs the ability to decide the importance of internet content leaves the potential for the medical and academic community to suffer. Additionally, we can expect slower internet speeds affecting the ability to live-stream, upload and download promptly. Overall, a divide will be created between those who can afford faster internet service and those who are stuck with the slower bandwidth.

What does this mean for physicians?

For physicians and health care professionals, the repeal of net neutrality could be detrimental. First, professionals run the risk of paying significantly more for high-speed internet capable of downloading, uploading, sending and receiving digital medical records. Also, all the advancements made in telemedicine recently could become stagnant. Despite the recent advancements, the future of telemedicine remains uncertain because even if the doctor can afford the high-speed internet to treat patients, many patients may not be able to afford the high-speed internet capable of live-streaming with their doctor.

Likewise, the education of doctors will be impacted significantly. For medical students, there is potential for an increase in tuition since it will cost more for high-speed internet capable of downloading and uploading medical books and research vital to their education. For doctors, it will become harder to stay up-to-date on the most recent research and studies in their field. Educational and non-profit websites will be overshadowed by commercial websites paying ISPs, making it harder to access scholarly research. Finally, the competition created between commercial websites and educational and non-profit websites will hinder and slow-down research. Overall, net neutrality has created a level playing field on the World Wide Web. It has made possible technological advancements that empower physicians with the education and tools they need to best care for their patients.

How can you make a difference?

On Wednesday, May 17, 2018, the Senate voted to reinstate the net neutrality rules repealed in December. The legislation is currently in the House where it is given little hope of advancing. Contact your district’s representative and express your concerns over the end of net neutrality and the effects it will have on physicians and healthcare professionals.

UPDATE: On Dec. 14 the FCC voted 3-2 along party lines to repeal net neutrality regulations, handing a victory to telecom providers over the objections of tech companies including Netflix, Reddit and Etsy. Net neutrality regulations had prevented internet providers like Comcast and AT&T from blocking or slowing web traffic, or creating paid fast lanes. Instead, providers will be required to disclose their practices, with the FTC expected to police anti-competitive behavior. The FCC’s new rules could usher in big changes in how we use the internet.

The meeting began this morning with protesters gathered outside the FCC, but the expected decision didn’t take very long to reach and fell along party lines.

FCC Chairman Ajit Pai, a Republican who says his plan to repeal net neutrality will eliminate unnecessary regulation, called the internet the “greatest free-market innovation in history.” He added that it “certainly wasn’t heavy-handed government regulation” that’s been responsible for the internet’s “phenomenal” development. “Quite the contrary,” he says.

“What is the FCC doing today?” he asked. “Quite simply, we are restoring the light-touch framework that has governed the internet for most of its existence.”

Broadband providers, Pai says, will have stronger incentives to build networks, especially in underserved areas. Ending 2015 net neutrality rules, he says, will lead to a “free, more open internet.”

“The sky is not falling, consumers will remain protected and the internet will continue to thrive,” Pai says.

THURSDAY, DEC. 7: Thousands of Americans protested across the country in all 50 states in support of continued net neutrality, the basic principle that prohibits internet service providers like AT&T, Comcast and Verizon from speeding up, slowing down, or blocking any content, applications or websites. Put simply, net neutrality is how the internet has always worked. In 2015 the Federal Communications Commission made history by placing broadband under Title II regulation in an attempt to permanently safeguard net neutrality. Now the Obama-era regulations may be repealed.

Although net neutrality rules make it illegal for high-speed Internet service providers to throttle speeds or block or slow down specific content, some health care experts worry the industry, and especially rural organizations, will struggle with the policy changes. While advocates of a repeal suggest there could be room for more competition and lower prices, others disagree arguing that if net neutrality rules are repealed, larger health care organizations may fare better than smaller ones simply because they can absorb the costs. Rural and community health centers may be left to struggle without the resources to pay for a fast internet connection on a tiered system.

Health care organizations rely on the web for telemedicine as well as data storage crucial because of government-mandated use of electronic health records. Even if the FCC were to create exemptions for health care providers or telehealth vendors, it would be difficult, if not impossible, to apply those same exemptions to patients on the other end. For homebound patients benefiting from advancements in remote monitoring, slower connectivity may not meet the demands of new technology that continuously transmits data to a primary care physician or relies on a video feed.

I am writing this from an airplane. Often, when I hop on a plane — particularly for a long flight — I wait for the ascent to 10,000 feet and immediately jump onto public Wi-Fi, just as I do in coffee shops, the dentist’s office, and pretty much anywhere else I can grab a signal. But that was before I spent an hour chatting with Joe Gervais, director of security communications at LifeLock, and part-time hacker (though Gervais points out, he hacks “only for good”). The point of the conversation was to figure out when it’s okay to use public Wi-Fi, when it’s not, and what you can do instead. Here’s what I learned…

What is public Wi-Fi? Any Wi-Fi that’s shared with someone other than yourself and the members of your household. A guest account that’s been set up for visitors to a particular company? Hotel Wi-Fi, free or not? In-flight Wi-Fi? Public, public and public. It doesn’t matter if it’s free or you pay a fee, or if it’s password protected.

Get that? Even if the Wi-Fi network requires a password, that doesn’t mean it’s safe.

What danger does that pose for me? Whenever computers are on a shared network, all the data is flowing over shared “wires.” Every computer on the network can see all the data flowing over that network. The default behavior, Gervais explains, is to ignore data that isn’t meant for your machine. But if you’re technically savvy and so inclined, you can, essentially, flip a switch and see everything. Most of it, he says, is garbage unless you’re a “network geek, a hacker, or attacker.” Then you can learn things that could be used, for example, in targeted phishing attacks.

For example? Say you’re a veteran, and you’re researching PTSD. You go online to search the terms, “PTSD” and “treatment.” Maybe you look up a local treatment center or a Veterans Administration support group. How much information an attacker can glean depends on the kinds of website pages you visit.

If you’re on secure websites (which have “https” in the URL address) vs. insecure ones (which have only “http”), the attacker can see the site itself, but not the page you went to. Visit enough sites, though, and it still might give someone enough information to launch a relevant phishing attack against you.

Even downloading apps on public Wi-Fi is to be avoided. A sophisticated attacker could pose as that app telling you there’s an update and use that via phishing to get you to give up personal information—your financial info, for instance, if you were downloading a bank’s app.

This is getting very scary. You’re telling me. But there a few things you can do to keep yourself safer.

Limit your behavior on public Wi-Fi. Don’t do anything on your browser that you wouldn’t do if a stranger was sitting next to you staring at your screen, Gervais says. That means no transacting. It also means not sending emails that contain sensitive information. You’re better off picking up the phone or, if that’s not possible, texting.

Use a VPN app. VPNs are virtual private networks and they come in app form for your smartphone and tablet. This creates an encrypted channel, so your online business is protected from prying eyes. Some good ones include WiTopia and F-Secure Freedome. You will find plenty of free ones in the app store, but Gervais cautions: “If you’re not paying for the VPN, you the user, are the product.” Use your hotspot. If you don’t want to go the VPN route, use cellular data on your phone and, for your computer or tablet, connect using the personal hotspot on your phone. Now that many of the cellular carriers are going to unlimited data, you can feel better about using it freely.

Oh, and while you’re at it, make sure your home Wi-Fi network is protected with a strong password. You don’t want neighbors “borrowing” your bandwidth, slowing your internet connection, or — if they’re so inclined — seeing what you’re doing online.

Contributed by LifeLock, which is a partner with the Medical Association. Medical Association members receive a discount on LifeLock memberships. Click to learn more.